According to the Centers for Disease Control and Prevention, there were nearly 58 opioid prescriptions written for every 100 Americans in 2017; the same year, prescription opioids were involved in more than 35% of all opioid overdose deaths. The factors contributing to this opioid crisis are many, including the prevalence of these drugs in the “treatment” of back pain.
If you’re considering lumbar spinal fusion, you’ve likely been suffering from chronic back pain for some time, which may have prompted you to consider using opioids yourself. You might expect that fusion surgery should eliminate your pain, and your need for painkillers; however, recent studies have shown that’s not usually the case.
In this article we’ll take a closer look at two individual studies, both of which contribute to a larger body of work that supports two ideas:
- For many patients, the use of opioids after lumbar fusion surgery (beyond the spinal fusion recovery period) is due to the failure of fusion to relieve pain.
- Opioid users are at a higher risk of long-term use post-surgery, therefore, discontinuation of opioids prior to surgery is recommended.
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In this particular study, researchers set out to uncover trends in chronic opioid users (prescription within 3 months pre-surgery) versus naive users (no prescription pre-surgery) as related to lumbar fusion. More than 25,000 patients participated in the study; most were over 50 years of age. Nearly one-third of the patients were on prescription opioids before surgery.
Some notable findings from the study:
- Postoperative opioid use fell dramatically during the first three months, but half of patients remained on the painkiller one year later.
- Preoperative opioid use appeared to be a major driver of prolonged postoperative consumption.
Study 2: “Use of Prescription Opioids Before and After An Operation For Chronic Pain (Lumbar Fusion Surgery)”
Here, researchers sought to determine what fraction of long-term preoperative opioid users discontinue or reduce dosage postoperatively and what fraction of patients with little preoperative use initiate long-term use. The results follow:
- Among patients with no preoperative opioids, 12.8% became long-term users.
- Among long-term preoperative users, 77.1% continued long-term postoperative use and 13.8% had episodic use; 44.8% received a higher long-term dose postoperatively.
Fewer than one in 10 people taking long-term opioids for back pain before surgery discontinued their medication after lumbar spinal fusion surgery—and some patients who weren’t taking the drugs prior to surgery began doing so after.
1. For many patients, the use of opioids after lumbar fusion surgery (beyond the spinal fusion recovery period) is due at least in part to the failure of fusion to relieve pain.
The fact that a number of patients in both studies began taking opioids for pain when they hadn’t been using them long-term before indicates a failed surgery. Many people have difficulty managing severe back pain before a lumbar fusion, and expect that the pain will be reduced significantly after surgery. But that’s not what most studies show.
- One study comparing lumbar fusion with non-surgical treatment in patients with chronic low back pain showed that lumbar fusion was not superior to cognitive intervention and exercises at relieving symptoms, improving function, and eventual return to work.
- Another study found that fusion provides good clinical results in the short term, but from two to 15 years after surgery the outcome worsened significantly. Over 35% of patients required a new surgical treatment because of adjacent segment degeneration.
- A review article noted that, when compared with other surgical procedures performed for non life-threatening conditions, the success rates for spinal surgery (particularly lumbar fusion) are poor—somewhere between 30% and 46%.
2. Opioid users are at a higher risk of long-term use post-surgery, therefore, discontinuation of opioids prior to surgery is recommended.
Opioids are highly addictive, therefore, patients who were using them continuously before surgery are likely to continue using them after, notwithstanding their actual pain level. And while prescribing rates have declined in the last few years—meaning health care providers are being more cautious about when they prescribe and days/dosages of prescriptions—it’s still a common practice. A few days of painkillers are appropriate during the spinal fusion recovery phase, but many patients go on taking them for longer.
To help reduce the likelihood of becoming dependent on opioids after lumbar spinal fusion, it’s advisable to totally cease use well before surgery and discontinue all opioids in less than six weeks post-op.
In short, if you’re considering lumbar spinal fusion, we encourage you to research all your treatment options thoroughly, and be aware of the dangers associated with chronic opioid use among fusion patients.